Elevated follicular fluid concentrations of ultraviolet filters associated with diminished ovarian reserve: A case-control study

Ultraviolet filters (UVFs) are widely used in personal care products, their occurrence in the environment and potential detrimental effects on human health have raised significant concerns. This case-control study included 102 women—34 with diminished ovarian reserve (DOR) and 68 healthy controls—and aimed to investigate the association between UVF exposure and DOR. We collected and analyzed follicular fluid (FF) samples from women diagnosed with DOR and compared them to samples from a control group, measuring the concentrations of 16 different UVFs. Four individual compounds showed significantly higher concentrations in the DOR group: octyl methoxycinnamate (OMC), UV-P, UV-328, and Ensulizole. The cumulative concentration of ten UVFs with detection frequencies above 50 % was also markedly elevated in the DOR group (median ΣUVFs: 178.96 ng/mL vs. 23.93 ng/mL, p < 0.001). OMC exhibited the highest median concentration (170.81 ng/mL in DOR vs. 20.77 ng/mL in controls, p < 0.001), followed by UV-P, UV-328, and Ensulizole. Spearman analysis revealed significant negative correlations between OMC concentrations with ovarian reserve biomarkers such as anti-Müllerian hormone (AMH), antral follicle count (AFC), and the number of oocytes retrieved during ovarian stimulation cycles, while exhibiting a positive correlation with follicle-stimulating hormone (FSH) levels. Adjusted logistic regression models demonstrated that elevated OMC levels were associated with a 3.8-fold increased risk of DOR (95 % CI: 1.943–9.782, p < 0.001). These results highlight the urgent need for further investigation into the mechanisms by which UVFs affect ovarian reserve, as well as their potential long-term implications for fertility.